Issues of optimization of management of patients with discogenic lumbosacral radiculopathy

Background. Discogenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pain, but more often accompanied by a long disabilities. To improve patient management with DLSR, the study of conservative and surgical management of patients in real clinical practice is required....

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Main Authors: Vladislav S. Prokopovich, Vladimir A. Parfenov
Format: Article
Language:Russian
Published: ZAO "Consilium Medicum" 2021-11-01
Series:Consilium Medicum
Subjects:
Online Access:https://consilium.orscience.ru/2075-1753/article/viewFile/96612/70884
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author Vladislav S. Prokopovich
Vladimir A. Parfenov
author_facet Vladislav S. Prokopovich
Vladimir A. Parfenov
author_sort Vladislav S. Prokopovich
collection DOAJ
description Background. Discogenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pain, but more often accompanied by a long disabilities. To improve patient management with DLSR, the study of conservative and surgical management of patients in real clinical practice is required. Aim. Optimization of patient management aimed at surgical treatment. Materials and methods. Surgical treatment (microdiskectomy) due to the ineffectiveness of conservative DLSR was suffered by 90 patients (33 men, 57 women, average age 59.7812 years). The duration of the disease to operation ranged from 2 to 14 weeks and was an average of 63 weeks. The intensity of pain was evaluated on a visual analog scale (VAS), disability on Oswestry Disability Index (ODI) and RolandMorris Disability Questionnaire (RMDQ) before the operation, after 10 days, 1, 3 and 6 months after surgery. Results. Patients were not informed about the favorable course of the DLSR, the possibilities of natural (without surgical intervention) of the regression of the disk hernia, as well as expediency to maintain all types of activity, avoid a long bed mode. After microdiskectomy after 10 days, significant reliable (p0.01) decrease in pain with 7 (95% confidence interval CI 78) to 4 (95% CI 34) points for VAS and reduction of disability with 13 (95% CI 1216) to 9 (95% CI 711) RMDQ points, from 63 (95% CI 6165) to 32 (95% CI 3034) % by ODI. After 1, 3 and 6 months, a further decrease in pain was observed [6 months to 3 (95% CI 23) points for VAS] and a decrease in disability [6 months to 5 (95% CI 47) points for RMDQ and up to 18 (95% CI 1719) % on ODI]. To reduce the intensity of pain 6 months after the operation, it was significantly (p0.05) influenced the initial intensity of pain according to VAS and conducting kinesitherapy after the operation. To reduce the disability in RMDQ after 6 months, the initial disability in RMDQ and the conduct of kinesitherapy after surgery was significantly (p0.05) influenced. Conclusion. Patients with DLSR should be informed about the favorable course of the disease, the possibilities of natural (without surgical intervention) of the regression of the disc hernia; after performing surgical treatment, it is advisable to the kinesitherapy, capable of improving the functional recovery of patients.
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spelling doaj.art-45bcdaad72234c6489c8a856b080c2fb2022-12-22T00:04:09ZrusZAO "Consilium Medicum"Consilium Medicum2075-17532542-21702021-11-01231182983310.26442/20751753.2021.11.2011524321Issues of optimization of management of patients with discogenic lumbosacral radiculopathyVladislav S. Prokopovich0https://orcid.org/0000-0002-9372-3018Vladimir A. Parfenov1https://orcid.org/0000-0002-1992-7960Sechenov First Moscow State Medical University (Sechenov University)Sechenov First Moscow State Medical University (Sechenov University)Background. Discogenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pain, but more often accompanied by a long disabilities. To improve patient management with DLSR, the study of conservative and surgical management of patients in real clinical practice is required. Aim. Optimization of patient management aimed at surgical treatment. Materials and methods. Surgical treatment (microdiskectomy) due to the ineffectiveness of conservative DLSR was suffered by 90 patients (33 men, 57 women, average age 59.7812 years). The duration of the disease to operation ranged from 2 to 14 weeks and was an average of 63 weeks. The intensity of pain was evaluated on a visual analog scale (VAS), disability on Oswestry Disability Index (ODI) and RolandMorris Disability Questionnaire (RMDQ) before the operation, after 10 days, 1, 3 and 6 months after surgery. Results. Patients were not informed about the favorable course of the DLSR, the possibilities of natural (without surgical intervention) of the regression of the disk hernia, as well as expediency to maintain all types of activity, avoid a long bed mode. After microdiskectomy after 10 days, significant reliable (p0.01) decrease in pain with 7 (95% confidence interval CI 78) to 4 (95% CI 34) points for VAS and reduction of disability with 13 (95% CI 1216) to 9 (95% CI 711) RMDQ points, from 63 (95% CI 6165) to 32 (95% CI 3034) % by ODI. After 1, 3 and 6 months, a further decrease in pain was observed [6 months to 3 (95% CI 23) points for VAS] and a decrease in disability [6 months to 5 (95% CI 47) points for RMDQ and up to 18 (95% CI 1719) % on ODI]. To reduce the intensity of pain 6 months after the operation, it was significantly (p0.05) influenced the initial intensity of pain according to VAS and conducting kinesitherapy after the operation. To reduce the disability in RMDQ after 6 months, the initial disability in RMDQ and the conduct of kinesitherapy after surgery was significantly (p0.05) influenced. Conclusion. Patients with DLSR should be informed about the favorable course of the disease, the possibilities of natural (without surgical intervention) of the regression of the disc hernia; after performing surgical treatment, it is advisable to the kinesitherapy, capable of improving the functional recovery of patients.https://consilium.orscience.ru/2075-1753/article/viewFile/96612/70884discogenic lumbosacral radiculopathythe hernia of the intervertebral diskmagnetic resonance tomography of the spinenon-steroidal anti-inflammatory drugsepidural administration of anesthetics and corticosteroidsanti-epileptic agentskinesitherapy
spellingShingle Vladislav S. Prokopovich
Vladimir A. Parfenov
Issues of optimization of management of patients with discogenic lumbosacral radiculopathy
Consilium Medicum
discogenic lumbosacral radiculopathy
the hernia of the intervertebral disk
magnetic resonance tomography of the spine
non-steroidal anti-inflammatory drugs
epidural administration of anesthetics and corticosteroids
anti-epileptic agents
kinesitherapy
title Issues of optimization of management of patients with discogenic lumbosacral radiculopathy
title_full Issues of optimization of management of patients with discogenic lumbosacral radiculopathy
title_fullStr Issues of optimization of management of patients with discogenic lumbosacral radiculopathy
title_full_unstemmed Issues of optimization of management of patients with discogenic lumbosacral radiculopathy
title_short Issues of optimization of management of patients with discogenic lumbosacral radiculopathy
title_sort issues of optimization of management of patients with discogenic lumbosacral radiculopathy
topic discogenic lumbosacral radiculopathy
the hernia of the intervertebral disk
magnetic resonance tomography of the spine
non-steroidal anti-inflammatory drugs
epidural administration of anesthetics and corticosteroids
anti-epileptic agents
kinesitherapy
url https://consilium.orscience.ru/2075-1753/article/viewFile/96612/70884
work_keys_str_mv AT vladislavsprokopovich issuesofoptimizationofmanagementofpatientswithdiscogeniclumbosacralradiculopathy
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